64层螺旋CT对先天性脊柱侧弯的术前评估及测量价值

目的 探讨螺旋CT对脊柱侧弯术前评估的价值.方法 脊柱侧弯患者90例,行64层螺旋CT扫描,根据侧弯程度确定扫描范围,并对所取得的数据进行重组.螺距0.75、扫描层厚5 mm或10 mm、重组层厚1 mm,间隔0.5 mm.重组方法为MPR法,在SSD或VRT图像上调整重组出每一椎体的最佳椎弓根横断位图像.逐一测量椎弓根横径、椎弓根深度、椎管横径、椎弓根轴线与椎体、棘突纵轴夹角.结果 90例脊柱侧弯患者的MPR重组图像均能清晰显示椎弓根层面,并能同时显示椎体本身、椎管、椎旁组织的情况.以上参数均能准确测量.结论 螺旋CT多平面重组技术对脊柱侧弯患者术前评估有着极其重要的作用.     

螺旋CT在先天性脊柱侧弯诊断中的应用

目的 探讨16层螺旋CT对先天性脊柱侧弯的诊断价值.方法 收集自2007-06-2010-04经放射学检查和临床诊治的先天性脊柱侧弯患者40例.术前均行16层螺旋CT扫描,然后在工作站完成多平面和曲面重组(MPR/CPR)、表面最大密度投影(SurMIP)和容积重建(VR),评价不同后处理图像的应用价值.结果 VR可以清晰评价先天性脊柱侧弯的所有相关表现,尤其适用于脊柱侧弯的分类.MPR/CPR重建图像能清晰显示椎弓根层面,显示畸形椎体、椎管并进行椎体旋转角度测量.40例先天性脊柱侧弯中,脊柱侧弯越重则顶椎的旋转度数越大,各椎体椎弓根矢状径均大于横径且凹侧椎弓根横径均小于凸侧,相邻椎体有类似表现.SurMIP可以用来测量脊柱侧弯角度,类似于X线片.结论 MSCT的后处理技术对矫形手术方法的制定有重要价值.     

数字平板CT成像技术在椎体后凸矫形术中的应用价值

目的:探讨数字平板CT成像技术在经皮椎体后凸矫形术中的应用价值.方法:对行PKP治疗的25例患者(34个椎体),在手术前后应用数字平板CT成像技术进行图像采集,对所获图像进行测量并与常规X线透视图像对照分析.结果:图像质量均为优质,靶椎体在数字平板CT成像与常规X线透视图像中的表现不尽相同.34个伤椎椎体前缘及中部由术前平均丢失高度(14.70±4.21)mm和(10.62±4.11)mm,改善至术后(10.38±4.23)mm和(6.45±4.04)mm;手术前后差异有显著性意义(P＜0.01).Cobb角由术前的(21.15±6.33)°,矫正至术后(11.64±4.32)°,手术前后差异有显著性意义(P＜0.01).结论:数字平板CT成像技术对伤椎椎体丢失高度抬升率的计算准确,对PKP术后疗效评价有明显的临床应用价值.     

前路有限减压单节段植骨内固定治疗Denis B型胸腰椎爆裂骨折

目的 探讨前路有限减压相邻椎体单节段植骨内固定治疗Denis B型胸腰椎爆裂骨折的可行性及临床疗效.方法 回顾性分析10例应用前路有限减压相邻椎体单节段植骨内固定术治疗Denis B型胸腰椎爆裂骨折的患者,观察复位、植骨融合、神经功能恢复、矫正丢失、腰痛、腰椎活动情况及融合椎体相邻椎间盘退变等并发症发生情况.结果 所有患者术后均获得6～29 个月(平均14个月)的随访.术后随访3～5 个月时达骨性融合,所有患者均获得满意复位,复位率达95%.重建的椎体高度无丢失,神经功能恢复1～2级.术后腰痛症状明显缓解,未出现顽固性腰痛、腰椎活动受限等并发症.融合节段相邻椎问盘未见明显退变,临床效果优于多节段内固定. 结论只要适应证选择合适,前路有限减压相邻椎体单节段植骨内固定可达到满意复位、坚强骨性融合、良好的神经功能恢复,且较三椎体二节段固定可减少固定节段、降低腰椎活动受限及相邻椎间盘退变等并发症的发生.     

中国优秀艺术体操运动员脊柱侧弯特征

目的:分析和研究中国优秀艺术体操运动员脊柱侧弯的特征。方法:使用LDR-01(Low-Dose Directly Digital Radiographic Device)低剂量数字化全脊柱摄影技术,获得26名国家队优秀艺术体操运动员自然站立姿势下的全脊柱无缝拼接影像。通过专业分析软件Img Viewer对X线片进行处理和测量,获得所有受试者在三解剖学平面上的脊柱侧弯Cobb角、顶椎位置、颈椎和腰椎曲度、椎体旋转程度等特征指标。结果:(1)冠状面脊柱侧弯发生率为53.85%;(2)矢状面脊柱侧弯发生率达100%,均出现颈椎反弓、腰椎曲度异常现象;(3)水平面脊柱侧弯发生率达88.46%,86.79%的旋转椎体位于脊柱胸段。结论:中国艺术体操国家队优秀运动员的脊柱侧弯发生率高。具有冠状面侧弯顶椎集中在下胸段并凸向右侧、矢状面脊柱曲度明显消失、水平面易发上胸段椎体右旋畸形的三维特征。     

用峰值跟踪法行颅脑动脉期CT增强扫描

目的:对进行颅脑部动脉期CT增强扫描时,排除各种影响因素对扫描延迟时间的影响。方法:在平扫图像中的胸主动脉进行标记;在注射对比剂10~15s后,每1s、2s或3s各进行扫描一次;当胸主动脉CT值超过100HU时,立即按下扫描按键,3s后CT机进行扫描。结果:38例进行颅脑部动脉期CT值峰值跟踪扫描的患者,动脉期颅脑部显示满意度达到100%,对扫描出的图像进行胸主动脉CT值测量,其值平均为269HU。结论:用峰值跟踪的方法进行颅脑部动脉期CT增强扫描比人为估计延迟时间的方法精确,扫描效果好。     

改良胸腰椎前路固定技术治疗胸腰椎骨折的临床观察

目的 改良胸腰椎前路固定技术以减少失血晕、提高椎体一次性置钉成功率。方法 仅结扎骨折椎体术侧椎体血管，切除骨折椎相邻上、下椎问盘，保留大部分软骨终板后椎体置钉，取髂骨，再切除椎体行椎管减压，撑开骨折间隙行髂骨块结构性植骨，置放钢板矫形加压锁定。结果 采用此技术，治疗胸腰椎骨折87例，其中新鲜骨折76例，术中失血400～800ml，平均560ml，手术时间2．5～3h；陈旧性骨折11例，术中失血800～l200m1，平均l080ml，手术时间3．5～4h。脊椎后凸畸形完全矫正8l例，残余5^。～8^。后凸畸形4例,前凸畸形2例。术后瘫痪基本恢复者39例，部分恢复者28例，小部分恢复者9例,无恢复11例。无一例术后神经症状加重。结论 改良胸腰椎前路操作技术可明显减少术中失血、缩短手术时间,提高了椎体一次性置钉的成功率。     

胸主动脉供血与腹主动脉供血肺隔离症的对比分析

目的：对比分析胸主动脉供血与腹主动脉供血肺隔离症的影像学征象。方法：回顾性分析经术后病理证实的23例肺隔离症病例,对比分析胸主动脉供血及腹主动脉供血肺隔离症的CT 图像。结果：23例肺隔离症中,16例由胸主动脉供血,其中7例有2支供血动脉;7例由腹主动脉供血。21例表现为实性软组织密度,1例胸主动脉供血者表现为囊实性不均匀密度,1例胸主动脉供血者表现为局部粗大血管。胸主动脉供血动脉直径（4．8±2．2）mm,长度（37±12）mm,腹主动脉供血动脉直径（3．3±0．5）mm,长度（104±42）mm。胸主动脉供血血管长度及隔离肺组织体积均小于腹主动脉供血（P均＜0．001）。结论：胸主动脉供血及腹主动脉供血肺隔离症的肺内表现相似,胸主动脉与腹主动脉供血动脉长度及隔离肺组织体积存在差异。     

后纵膈海绵状血管瘤CT误诊1例

正患者女,56岁。2周前无明显诱因咳嗽,呈阵发性刺激性连声咳嗽,咳白痰且不易咳出。前胸部隐痛,呈持续性,伴气短,活动后加重,休息后减轻。无发热、咯血,心悸等症状。CT平扫及增强扫描显示:左侧后下纵隔见类圆形肿块影,大小约6. 0cm×5. 5cm×7. 5cm,其前缘推移心影后缘,内缘与胸主动脉及椎体相邻,其余边缘光整。其内密度不均     

胸腰椎影像学测量及其临床意义

目的通过测量国人脊柱胸腰段（T11～L4）椎体高度、矢状径、横径,为设计胸腰椎椎体内固定器提供理论依据。方法健康正常人50例（男女各25例）,年龄18～60岁（平均30.6±10.5岁）,无腰椎病变者行CT扫描,分别测量胸腰椎椎体高度及椎体上、中、下矢状径和横径。结果胸腰椎椎体高度从T11～L4逐渐增高,中央高度与前缘高度、后缘高度比较,以中央高度最小,其范围为20.45～25.55mm（女：19.77～25.30mm）,前缘高度为21.24～27.41mm（女：20.84～26.22mm）,后缘高度为22.60～26.76mm（女：21.68～26.14mm）;正中矢状径、横径从T11～L4逐渐增大,椎体中部的矢状径和横径与椎体上、下的矢状径和横径比较,有显著差异（P〈0.05）,以腰部最小,其范围分别为28.56～33.36mm（女：27.63～31.42mm）、32.71～46.57mm（女：31.68～44.83mm）。椎体上矢状径和横径范围分别为30.67～37.71mm（女：29.23～36.51mm）、36.85～51.81mm（女：34.31～48.89mm）。椎体下矢状径和横径范围分别为32.24～39.31mm（女：31.14～37.99mm）、38.97～52.94mm（女：37.88～50.80mm）。总体观椎体上下呈向中间凹陷,腰部凹陷的类圆柱体。结论设计胸腰椎单椎体内固定器械时应考虑到各椎体高度及矢状径、横径的大小不同。     

The normal distribution of thoracoabdominal aorta small branch artery ostia

The purpose of this study was to determine the normal distribution of aortic branch artery ostia. CT scans of 100 subjects were retrospectively reviewed. The angular distributions of the aorta with respect to the center of the T3 to L4 vertebral bodies, and of branch artery origins with respect to the center of the aorta were measured. At each vertebral body level the distribution of intercostal/lumbar arteries and other branch arteries were calculated. The proximal descending aorta is posteriorly placed becoming a midline structure, at the thoracolumbar junction, and remains anterior to the vertebral bodies within the abdomen. The intercostal and lumbar artery ostia have a distinct distribution. At each vertebral level from T3 caudally, one intercostal artery originates from the posterior wall of the aorta throughout the thoracic aorta, while the other intercostal artery originates from the medial wall of the descending thoracic aorta high in the chest, posteromedially from the mid-thoracic aorta, and from the posterior wall of the aorta low in the chest. Mediastinal branches of the thoracic aorta originate from the medial and anterior wall. Lumbar branches originate only from the posterior wall of the abdominal aorta. Aortic branch artery origins arise with a bimodal distribution and have a characteristic location. Mediastinal branches of the thoracic aorta originate from the medial and anterior wall. Knowing the location of aortic branch artery ostia may help distinguish branch artery pseudoaneurysms from penetrating ulcers.     

胸椎孤立性浆细胞瘤1例及文献复习

目的探讨胸椎孤立性浆细胞瘤(SPB)的临床表现、影像特征及鉴别诊断。方法分析1例脊柱SPB病人的CT及MRI表现,并复习相关文献。结果 CT示T10椎体呈楔形,轻度膨胀性、溶骨性骨质破坏,边缘骨硬化,内部见残存骨嵴,未见典型"微脑征"。瘤体均质,未见钙化及肿瘤骨。MRI平扫示病变于T1WI呈低信号,T2WI呈稍高信号,T2WI脂肪抑制序列呈高信号,MRI增强示瘤体呈均匀强化,未见椎旁肿块及脓疡,相邻椎间盘信号无异常。手术病理提示浆细胞来源肿瘤,结合ECT及本周蛋白、血钙及肌酸水平,临床诊断为SPB。结论 SPB好发于椎体前部,溶骨性破坏,瘤体均质,常伴有骨嵴及硬化边。"微脑征"有助于诊断,但敏感性较低。SPB的确诊有赖于影像检查、临床实验室及病理结果的综合分析。     

胸腰椎前路手术38例临床分析

目的 探讨胸腰椎前路手术术中和术后出现的问题，分析其原因，提出处理对策。方法 本组前路手术38例，术前、术后均行X线摄片及CT检查，将术前、术后资料加以对比，观察术后影像学检查中存在减压不彻底的位置及固定钉的长度、方向欠佳等问题，并在术中详细记录出血量、减压范围等，找出术中存在问题。结果 本组减压不彻底3例，术中出血过多8例，术中硬脊膜破裂5例。椎体钉位置方向及长度欠佳18例，术后轻度脊柱侧凸3例。结论 术前详细阅读CT片、仔细测量、充分术前准备及麻醉配合、术中显露良好、操作耐心细致、及时止血等均是避免出现问题的对策。应在椎体减压前打入螺栓，以保证螺钉位置及方向准备；采用逆行腰大肌瓣填塞以防术中硬脊膜破裂。     

Normal thoracic aortic diameters by computed tomography

Although computed tomography (CT) has played an important role in evaluation of the thoracic aorta, no standards for aortic dimensions exist. To establish the range of normal variation of aortic diameters, a retrospective study of 102 chest CT studies in adults without clinical evidence of hypertension, diabetes, cardiovascular disease, or renal disease was performed. The coronal aortic diameter was measured at three levels: just beneath the aortic arch, just above the aortic valve, and at the level of the diaphragm. These measurements showed substantial variation according to age, sex, and thoracic vertebral body width. The ratio between the ascending and descending limbs of the aorta varied markedly with age; younger individuals had significantly higher ratios than older age groups. Knowledge of these values allows more precise CT evaluation in suspected aortic disease, specifically reducing the potential for "overinterpretation" of the normal, but prominent, ascending aortic root.     

CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

Objective

To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs.

Materials and methods

Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115° through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs.

Results

The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible.

Conclusions

The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography.     

Computed tomographic myelography in the investigation of childhood scoliosis and spinal dysraphism

The combined investigations of positive contrast myelography and computed tomographic (CT) myelography were performed on 53 consecutive children. Thirty-eight (72%) of these investigations were performed as a routine pre-operative procedure to identify occult spinal dysraphism in patients with childhood scoliosis; the remainder were because of the "orthopaedic syndrome", cervical radiculopathy, back pain and patients with clinical findings to suggest spinal dysraphism. In the 20 patients (38%) with idiopathic scoliosis, there was no case of spinal dysraphism and CT myelography provided no additional information to the myelogram. In the seven patients with spinal dysraphism the plain radiographic abnormalities identified were lumbar vertebral abnormalities (five), thoracic vertebral abnormalities (one), and sacral agenesis (one). Diastematomyelia was found in four patients, a low tethered cord and lipoma in two patients and a large lipoma in one patient. In all of these cases the myelogram indicated the intraspinal abnormalities; however, CT myelography provided more precise anatomical detail. We conclude that CT myelography is not indicated in the initial preoperative assessment of idiopathic scoliosis but should be reserved for patients with congenital or complicated scoliosis where the association with dysraphism is well recognised.     

Location of major vessels in prone-positioned patients undergoing percutaneous lumbar sympathectomy

Introduction

The topographic relationship between major vessels and the sympathectomy target is not identical across patients and may not be clear, especially in patients in the prone position. The aim of this study was to provide anatomic data regarding the location of the major vessels (i.e., vena cava and aorta) based on computed tomography (CT) images obtained during lumbar sympathectomy under CT fluoroscopic guidance.

Methods

Thirty-six patients with peripheral arterial occlusive disease or chronic pain syndrome were treated using fluoroscopic CT-guided percutaneous lumbar sympathectomy between April 2006 and March 2010. We analyzed the shortest distances between the sympathectomy target and the major vessels, and the relationship between the location of the major vessels and the vertebral anterior line using CT images obtained during the procedure.

Results

At the L3 level, the shortest distances from the right side target to the inferior vena cava were significantly shorter than the other distances (P?Conclusion Needle insertion for right side sympathectomy at the L3 level may present a higher risk of major vessel puncture than sympathectomy at other sites. CT guidance is recommended for lumbar sympathectomy to reduce the risk of vascular puncture.     

The posterior vertebral body line: importance in the detection of burst fractures

A review of the lateral radiographs and CT studies of 114 patients with burst fractures, 46 patients with combined injuries in whom bursting was a major component, and 82 patients with simple anterior compression fractures was performed to evaluate the integrity of the posterior vertebral body margin. This structure normally produces a single or bifid vertical line on the lateral radiograph. Disruption, displacement, or rotation of this line was found in all 114 patients with "pure" burst fractures. These abnormalities were also present in 36 of the 46 patients with combined burst injuries. In all patients with simple compression fracture, flexion, distraction or dislocation, and extension injuries, the line was normal. CT studies showed these abnormalities to be the result of retropulsion of one or more bone fragments from the posterior margin of the vertebral body. Disruptive abnormalities of the posterior vertebral body line are reliable plain-film signs that a burst fracture has occurred and that compromise of the vertebral canal and subarachnoid space is present.     

Imaging features of spinal osteoid osteoma with emphasis on MRI findings

A retrospective evaluation of the imaging of 13 patients with a diagnosis of osteoid osteoma (OO) of the spine was undertaken. Available imaging included radiographs (n=10), computed tomography (CT) (n=13), bone scintigraphy (n=5) and magnetic resonance imaging (MRI) (n=13). MRI features evaluated were pattern of neural arch and vertebral body oedema and the presence of an identifiable nidus. MRI features were correlated with other available imaging. There were seven males and six females with an age range of 8–59 years. On radiographs, scoliosis was present in ten and a sclerotic pedicle in nine patients. Focal increased uptake on bone scintigraphy consistent with OO was seen in all five patients where scintigraphy was available. On CT, a nidus was identified in all patients and reactive sclerosis was seen in 12. MRI demonstrated the nidus in eight patients and unilateral neural arch oedema with anterior extension to involve the ipsilateral posterolateral vertebral body in 11. When MRI is performed in the evaluation of back pain, the presence of unilateral neural arch oedema extending to involve the posterolateral vertebral body raises the possibility of spinal OO and should prompt CT to confirm the presence of a nidus.